1

2019 Adult Preventive Health Guidelines

Important Note
Health Net’s Preventive Health Guidelines provide Health Net members and practitioners with recommendations for preventive care
services for the general population, based on the recommendations of recognized clinical sources such medical associations and
specialty societies, professional consensus panels, and government entities such as the Center for Disease Control and Prevention
(CDC) and the United States Preventive Services Task Force (USPSTF). They are based on the best available medical evidence at
the time of release. These guidelines apply to those individuals who do not have symptoms of disease or illness. A Health Net
member’s medical history and physical examination may indicate that further medical tests are needed. Guidelines may also differ
from state to state based on state regulations and requirements. As always, the judgment of the treating physician is the final
determinant of member care. Member benefit plan may or may not cover all the services listed here. Please refer to the certificate of
coverage for complete details or contact the customer service number listed on the member’s ID card.

KEY TO MAJOR PROFESSIONAL ORGANIZATIONS REFERENCED IN THE GUIDELINES

AAP: American Academy of Pediatrics
ACIP: Advisory Committee on Immunization Practices of the CDC
ACS: American Cancer Society
ACOG: American Congress of Obstetricians and Gynecologists
ACPM: American College of Preventive Medicine (ACPM
AAFP: American Academy of Family Practice
AHA: American Heart Association
ADA: American Diabetes Association
AMA: American Medical Association
AUA: American Urological Association
CDC: Centers for Disease Control and Prevention
NCI: National Cancer Institute
USPSTF: U.S. Preventive Services Task Force

Routine Health  Frequency based on age and contract (annual – 2 years)

Examination  Baseline height and weight
 Blood Pressure Measurement
 Calculation of Body Mass Index
 Obesity: Clinicians should offer or refer patients with a body mass index
(BMI) of 30 kg/m2 or higher to intensive, multicomponent behavioral
interventions. (USPSTF)
Abdominal Aortic One-time screening for abdominal aortic aneurysm (AAA) with ultrasonography
Aneurysm in men ages 65 to 75 years who have ever smoked

Source USPSTF
Breast Cancer Note that different entities have different recommendations. All recommend
shared decision-making as to age, frequency and risk factors

Some states regulations allow for baseline mammography starting at age 35.
 2

USPSTF
Biennial screening mammography for women aged 50 to 74 years at average
risk. The decision to start screening mammography in women prior to age 50
years and to continue past the age of 74 should be an individual one

ACOG
Women should be offered mammography at age 40 but should start at 50.
Women at average risk of breast cancer should have screening mammography
every one or two years based on an informed, shared decision-making process
Beyond age 75 years, the decision to discontinue screening mammography
should be based on a shared decision making.

Sources: USPSTF, ACOG

BRCA TESTING: Providers should screen women who have family members with breast, ovarian,
tubal, or peritoneal cancer with 1 of several screening tools designed to identify
a family history that may be associated with an increased risk for potentially
harmful mutations in breast cancer susceptibility genes (BRCA1 or BRCA2).
Women with positive screening results should receive genetic counseling and, if
indicated after counseling, BRCA testing.

Source: USPSTF
Cervical Cancer Screening  Cervical cancer screening should begin at age 21 years.
 Women younger than 21 should not be screened, except for women who
are infected with HIV. More frequent screening is appropriate for certain
women, including those infected with HIV.
 Cervical cytology alone should be used for women aged 21 to 29 years, and
screening should be performed every three years.
 In women aged 30–65 years, screening with cytology alone every 3 years or
hrHPV testing alone ever 5 yrs is acceptable. Annual screening need not be
performed
 Women younger than 30 years should not undergo co-testing.
 Screening should be discontinued after age 65 years in women with
adequate negative prior screening test results.
 Routine cytology and HPV testing should be discontinued and not restarted
for women who have had a total hysterectomy and never had cervical
intraepithelial neoplasia 2 or higher.
 Women who have a history of cervical cancer, have HIV infection, are
immunocompromised, or were exposed to diethylstilbestrol in utero should
not follow routine screening guidelines and may need more frequent
screening.

Adequate negative prior screening results are defined as three consecutive

negative cytology results or two consecutive negative co-test results within the
previous 10 years, with the most recent test performed within the past 5 years.

Source: ACOG and USPSTF

 3

Colorectal Cancer (CRC) Screen age 50-75 for colorectal cancer using:
Screening  Guaiac Fecal Occult Blood Test (gFOBT) annually or;
 Fecal Immunochemical Testing (FIT) annually or;
 Fecal Immunochemical Testing (FIT)-DNA every 1-3 years or;
 Flexible sigmoidoscopy every 5 years or;
 Flexible sigmoidoscopy every 10 years with FIT annually or;
 Colonoscopy every 10 years or;
 CT Colonography every 5 years

For patients at high risk, colonoscopy should start at age 40 with screening
interval every 5-10 years. Note: Single–panel gFOBT performed in the medical
office using a stool sample collected during a digital rectal examination is not a
recommended option for CRC screening due to its very low sensitivity for
advanced adenomas and cancer.

Some entities recommend annual colorectal cancer screening in the 45 to 49

age group. The decision to start colorectal cancer screening before the age of
50 years should be an individual one and consider patient context, disease risk,
and include the patient’s preferences and values regarding specific benefit and
harm.

Sources: USPSTF, American Cancer Society

Lung Cancer Screen annually for lung cancer with low-dose computed tomography in adults
ages 55 to 80 years who have a 30 pack-year smoking history and currently
smoke or have quit within the past 15 years. Screening should be discontinued
once a person has not smoked for 15 years or develops a health problem that
substantially limits life expectancy or the ability or willingness to have curative
lung surgery.

Source: USFSTF
Prostate Cancer  Men ages 55 to 69 need to make an individual decision about prostate
(Prostatic Specific cancer screening with their clinician and should consider risk factors such as
Antigen- PSA) family history, race/ethnicity, life expectancy.
 The American Cancer Society (ACS) and the American Urological Association
(AUA) recommend an informed decision-making process for men age 50
and older (ACS) or men age 55-69 (AUA) who have at least a ten-year life
expectancy.
 The American Cancer Society emphasizes informed decision making for
prostate cancer screening: men at average risk should receive information
beginning at age 50 years, and black men or men with a family history of
prostate cancer should receive information at age 45 years.

The USPSTF recommends against routine screening for men age 70 and older.

Source: USPSTF, ACS, AUA

Osteoporosis (Bone All women aged 65 years or older and in younger women who are at increased
Mineral Density Testing) risk for osteoporosis as determined by a formal clinical risk assessment tool.
 4

Source: USPSTF
Abnormal Glucose or Screening for abnormal blood glucose as part of cardiovascular risk assessment
Type 2 Diabetes in adults aged 40 to 70 years who are overweight or obese. Persons with risk
Screening factors such as family history of diabetes or of certain ethnicities or race could
start screening sooner. Clinicians should offer or refer patients with abnormal
blood glucose to intensive behavioral counseling interventions to promote a
healthful diet and physical activity

The ADA recommends screening should be considered in adults of any age who
are overweight or obese (BMI >25 kg/m2) and who have one or more additional
risk factors for diabetes. In those without these risk factors, testing should
begin at age 45 years. If tests are normal, repeat testing should be carried out
at least at 3-year intervals.

Evidence on the optimal rescreening interval for adults with an initial normal
glucose test is limited. Studies suggest that rescreening every 3 y may be a
reasonable approach

Source: USPSTF, ADA

Cholesterol/Lipids Recommendations vary but in general:
 Screen men age 35 and older for lipid disorders.
 Screen women age 45 and older for lipid disorders if they are at increased
risk for coronary heart disease.
 Men age 20 to 35 and women age 20 to 45 that are at increased risk for
coronary heart disease should be screened for lipid disorder.
 Reasonable options for screening interval include: every 5 years; screening
at <5 year intervals for people who have lipid levels close to those
warranting therapy; and screening at intervals >5 years for low-risk people
who have had low or repeatedly normal lipid levels.

Source: USPSTF, AHA

Hepatitis B  Screen persons at high risk for infection (such as geographic location, HIV
positive, immunocompromised, household contacts or sexual partners of
persons with HBV infection, and men who have sex with men, persons
receiving hemodialysis)
 Screen pregnant women at their first prenatal visit.

Source: USPSTF
Hepatitis C  Screen in persons at high risk for infection (e.g., past or current injection
drug use, blood transfusion prior to 1992, long-term hemodialysis etc).
 For persons at high risk for infection and offer one-time screening for HCV
infection to adults born between 1945 and 1965

Source: USPSTF
 5

Human  Screen for HIV infection in adults age 18 to 65 years.

Immunodeficiency Virus  Older adults who are at increased risk should also be screened.
(HIV) Infection  Screen all pregnant women for HIV, including those who present in labor
who are untested and whose HIV status is unknown.
 The evidence is insufficient to determine optimum time intervals for HIV
screening.

Source: USPSTF
Sexually Transmitted Screen sexually active and those at high risk:
Infections (STI) Syphilis
Screenings and Screen pregnancy women and those at high risk for infection such those with a
Counseling: history of incarceration, history of commercial sex work, certain racial/ethnic
Syphilis, Chlamydia, groups, and being a male younger than 29 years, as well as regional variations.
gonorrhea
Chlamydia
All sexually active women 24 years of age or younger, including adolescents, are
at increased risk for chlamydial infection. The CDC recommends at least annual
screening for chlamydia for women at increased risk. The USPSTF recommends
screening for chlamydia in sexually active women age 24 years and younger and
in older women who are at increased risk for infection.

Gonorrhea
All sexually active women age 24 and younger and in older women who are at
increased risk for infection. In the absence of studies on screening intervals, a
reasonable approach would be to screen patients whose sexual history reveals
new or persistent risk factors since the last negative test result. Risk factors for
gonorrhea and chlamydia include a history of previous infection, other sexually
transmitted infections, new or multiple sexual partners, inconsistent condom
use, sex work and drug abuse

Counseling:
Intensive behavioral counseling for adults who are at increased risk for sexually
transmitted infections (STIs)

Source: USPSTF, CDC

Depression Screening for depression in the general adult population is recommended,
including pregnant and postpartum women. Screening should be implemented
with adequate systems in place to ensure accurate diagnosis, effective
treatment, and appropriate follow-up.

Source: USPSTF
Tobacco Screen all adults, including pregnant women, about tobacco use and
tobacco cessation interventions for those who use tobacco products and
pregnancy-tailored counseling for pregnant women who use tobacco.

Source: USPSTF
 6

Alcohol Misuse Screen adults 18 and over for alcohol misuse and provide persons engaged in
risky or hazardous drinking with brief counseling interventions to reduce
alcohol misuse

Source: USPSTF
Intimate Partner Screen women of childbearing age for intimate partner violence, such as
Violence domestic violence, and provide or refer women who screen positive to
intervention services.

Source: USPSTF
Fall Prevention in Older Exercise interventions are recommended to prevent falls in community-
Adults dwelling adults 65 years or older who are at increased risk for falls.

Source: USPSTF
Aspirin  Low-dose aspirin use for the primary prevention of cardiovascular disease
(CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a
10% or greater 10-year CVD risk, are not at increased risk for bleeding, have
a life expectancy of at least 10 years, and are willing to take low-dose
aspirin daily for at least 10 years.
 The decision to initiate low-dose aspirin use for the primary prevention of
CVD and CRC in adults aged 60 to 69 years who have a 10% or greater 10-
year CVD risk should be an individual one. Persons who are not at increased
risk for bleeding, have a life expectancy of at least 10 years, and are willing
to take low-dose aspirin daily for at least 10 years are more likely to benefit.

Source: USPSTF
Statins Adults without a history of cardiovascular disease (CVD) (ie, symptomatic
coronary artery disease or ischemic stroke) are recommended to use a low- to
moderate-dose statin for the prevention of CVD events and mortality when all
the following criteria are met:
 aged 40 to 75 years;
 have 1 or more CVD risk factors (ie, dyslipidemia, diabetes,
hypertension, or smoking);
 have a calculated 10-year risk of a cardiovascular event of 10% or
greater.

Identification of dyslipidemia and calculation of 10-year CVD event risk requires

universal lipids screening in adults aged 40 to 75 years

Source: USPSTF
Folic Acid All women planning or capable of pregnancy should take a daily supplement
containing 0.4 to 0.8 mg (400 to 800 µg) of folic acid.

Source: USPSTF
Pregnancy Refer to the American College of Obstetricians and Gynecologists Guidelines for
Preconception Care, Prenatal Care and Postpartum Care
 7

Counseling Advance Directives

Avoidance of tobacco and/or tobacco cessation
Calcium intake
Coping Skills/Stress Reduction
Depression screening for postpartum, MI, CVA and for those with chronic
medical conditions
Discuss chemoprevention for breast cancer if high risk
Domestic Violence (e.g., Intimate Partner Violence and Elderly Abuse; refer to
intervention services if applicable)
Fire safety (smoke detectors)
Firearm storage
HIV screening and counseling
Hormone Replacement Therapy: Counsel women 45 and older for pros and cons
Immunizations/Vaccinations
Injury and fall prevention
Mental Health Awareness
Minimizing exposure to ultraviolet radiation to reduce risk for skin cancer
Promote benefits of physical activity
Promotion of healthy diet
Risks and symptoms of endometrial cancer to women of average risk at the time
of menopause. Strongly encourage women to report and unexpected bleeding or
spotting
Seat belt use, helmet use
Tuberculosis screening if at risk
Unwanted Pregnancy Prevention
Vitamin D supplementation
Weight loss for obese adults

Review History: January 2003, March 2004, March 2005, April 2006, February 2007, February 2008,
March 2009, February 2010, February 2011, February 2012, November 2012, February 2013, May 2013,
February 2014, February 2015, May 2015, February 2016, May 2016, February 2017, April 2017, March
2018, September 2018, February 2019